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\author{Teas}
\pdfinfo{
  /Title (polycystc-ovarian-syndrome.pdf)
  /Creator (Cheatography)
  /Author (Teas)
  /Subject (POLYCYSTC OVARIAN SYNDROME Cheat Sheet)
}

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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{POLYCYSTC OVARIAN SYNDROME Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Teas} via \textcolor{DarkBackground}{\uline{cheatography.com/181443/cs/37754/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Teas \\
  \uline{cheatography.com/teas} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 16th March, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{DEFINITION}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Syndrome consisting of amenorrhea, hirsutism, and obesity in association with enlarged polycystic ovaries} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- "Classic" features: signs of elevated androgens, such as hirsutism, and oligomenorrhea or amenorrhea} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- 3-7\%} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Rotterdam criteria}} - two of these three criteria are required} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Menstrual irregularity}}} \tn 
% Row Count 10 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Symptoms or findings of hyperandrogenism}}} \tn 
% Row Count 11 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{ - Polycystic ovaries on US}}} \tn 
% Row Count 12 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Phenotype C}} - hyperandrogenism and polycystic ovaries in ovulatory women} \tn 
% Row Count 14 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Phenotype D}} - irregular cycles and polycystic ovaries in the absence of documented hyperandrogenism} \tn 
% Row Count 17 (+ 3)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Phenotype A}} - includes all three criteria with US findings of polycystic ovaries} \tn 
% Row Count 19 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Phenotype B}} - women with the NIH definition when there are no US findings} \tn 
% Row Count 21 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{AEPCOS}} - hyperandrogenism, polycystic ovaries on us or menstrual irregularity (anovulation)} \tn 
% Row Count 23 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CRITERIA FOR DIAGNOSIS OF PCOS}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1678983712_photo_2023-03-16_22-56-08.jpg}}} \tn 
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{OVARIAN MORPHOLOGY}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{- 12 or more peripherally oriented cystic structures (2-9 mm)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Total follicle count in each ovary - most diagnostic} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Ovarian volume of 10 ml or more} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Polycystic-appearing ovaries (PAO), polycystic ovarian morphology (PCOM), or simply PCO} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{THE DIAGNOSIS IN ADOLESCENCE}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{- Rotterdam criteria should not be used.} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- All three criteria are firmly in place and at a minimum of 3 years postmenarche} \tn 
% Row Count 3 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{MENSTRUAL IRREGULARITY}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{- Oligomenorrhea (cycles longer than 35 days)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Menstrual frequency of every few months} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Frank amenorrhea (longer than 6 months missed)} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Best correlate of insulin resistance in women with PCOS.} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Subfertility of women with PCOS} \tn 
% Row Count 6 (+ 1)
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ANDROGEN EXCESS OR HYPERANDROGENISM}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{- Ovary} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Adrenal gland} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Adrenal gland} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Adipose tissues} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{11-oxygenated androgens}} - most abundant androgens in women with PCOS} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CHARACTERISTIC ENDOCRINE FINDINGS}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{- Abnormal gonadotropin secretion} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{-  Increased gonadotropin-releasing hormone (GnRH) pulse amplitude} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Increased pituitary sensitivity to GnRH} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Elevated LH level or elevated LH/FSH ratio- not be used as diagnostic tools} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Increased levels of biologically active (non-sex hormone-binding globulin {[}shbg{]}-bound) estradiol} \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Increase estrone → increased peripheral (adipose) conversion of androgen} \tn 
% Row Count 10 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{-  Increased levels of biologically active estradiol → elevated LH levels and anovulation} \tn 
% Row Count 12 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Elevated androgens} \tn 
% Row Count 13 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Serum testosterone levels - 0.55 to 1.2 ng/ml} \tn 
% Row Count 14 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Androstenedione levels are usually from 3to5 ng/ml} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{INSULIN RERSISTANCE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Insulin and insulin-like growth factor 1 (IGF-1) enhance ovarian androgen production} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- High levels of insulin bind to the receptor for IGF-1} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- The granulosa cells also produce IGF-1 receptor and IGF-binding proteins (IGFBPs).} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Paracrine control}}} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-Enhancement of LH stimulation}}} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-Production of androgens by the theca cells}}} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Elevated insulin levels stimulate adipocyte production of adipokines interfere → with the metabolism and breakdown of adipose tissue and further enhance IR} \tn 
% Row Count 13 (+ 4)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Insulin resistance in peripheral tissues} \tn 
% Row Count 14 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Muscle}}} \tn 
% Row Count 15 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{ - Adipose }}} \tn 
% Row Count 16 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Ovary or adrenal}}} \tn 
% Row Count 17 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Signaling abnormalities} \tn 
% Row Count 18 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Euglycemia with peripheral IR} \tn 
% Row Count 19 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Severe cases - beta cell (secretory) dysfunction} \tn 
% Row Count 20 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Testing should be directed at ruling out diabetes and glucose intolerance} \tn 
% Row Count 22 (+ 2)
% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Measurement of the level of hemoglobin A1C} \tn 
% Row Count 23 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Prediabetes greater than 5.8\% }}} \tn 
% Row Count 24 (+ 1)
% Row 17
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Frank diabetes greater than 6\%}}} \tn 
% Row Count 25 (+ 1)
% Row 18
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Clamp test} \tn 
% Row Count 26 (+ 1)
% Row 19
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Intravenous frequent sampling glucose tolerance test, or insulin tolerance} \tn 
% Row Count 28 (+ 2)
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{ACANTHOSIS NIGRICANS (AN)}}} \tn 
% Row Count 29 (+ 1)
% Row 21
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- 30\% of hyperandrogenic women}}} \tn 
% Row Count 30 (+ 1)
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\par\addvspace{1.3em}

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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{INSULIN RERSISTANCE (cont)}}  \tn
% Row 22
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\mymulticolumn{1}{x{5.377cm}}{{\emph{- 50\% of women with PCOS who are hyperandrogenic and obese}}} \tn 
% Row Count 2 (+ 2)
% Row 23
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Velvety hyperpigmentation} \tn 
% Row Count 3 (+ 1)
% Row 24
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\mymulticolumn{1}{x{5.377cm}}{{\emph{- Nape of the neck}}} \tn 
% Row Count 4 (+ 1)
% Row 25
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Axilla}}} \tn 
% Row Count 5 (+ 1)
% Row 26
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-  Vulva regions}}} \tn 
% Row Count 6 (+ 1)
% Row 27
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{H}}yperandrogenism, {\bf{IR}}, and {\bf{AN}} (HAIR-AN syndrome)} \tn 
% Row Count 8 (+ 2)
% Row 28
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-Associated with insulin receptor antibodies }}} \tn 
% Row Count 9 (+ 1)
% Row 29
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-Very high insulin levels}}} \tn 
% Row Count 10 (+ 1)
% Row 30
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Severe IR}}} \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ACANTHOSIS NIGRICANS}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1678981081_photo_2023-03-16_23-32-01.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ANTIMÜLLERIAN HORMONE IN PCOS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Müllerian-inhibiting substance (MIS) or AMH} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-Glycoprotein produced by the granulosa cells of preantral follicles}}} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Elevated in women with PCOS}}} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Pathophysiology of anovulation in PCOS} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Used as a blood test to substitute for US findings of a polycystic ovary} \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{\textgreater{}4.7 ng/mL → PCOS}}} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PATHOPHYSIOLOGIC CONSIDERATIONS}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Genetic predisposition}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Susceptibility genes} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- 2p16.3}}} \tn 
% Row Count 3 (+ 1)
% Row 3
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\mymulticolumn{1}{x{5.377cm}}{{\emph{- 2p21}}} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- 9q33.3}}} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- LH/human chorionic gonadotropic (HCG) receptor thyroid adenoma locus }}} \tn 
% Row Count 7 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- DENND1A }}} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Environmental factors}}} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PATHOPHYSIOLOGIC CONSIDERATIONS}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1678981363_photo_2023-03-16_23-32-04.jpg}}} \tn 
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PATHOPHYSIOLOGIC CONSIDERATIONS}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{{\emph{- Genetic factors }}} \tn 
% Row Count 1 (+ 1)
% Row 1
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\mymulticolumn{1}{x{5.377cm}}{{\emph{- Environmental factors }}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Endocrine disturbances}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- PAO: normal menses, normal androgen levels, and normal ovulatory function and parity may develop a full-blown syndrome (PCOS)} \tn 
% Row Count 6 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Normal homeostatic factors → ward off stressors or insults} \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Homeostatic mechanisms → symptoms of PCOS to emerge with varying degrees of severity} \tn 
% Row Count 10 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- 2 Major insults} \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Weight gain }}} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Psychological stress}}} \tn 
% Row Count 13 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PATHOPHYSIOLOGIC CONSIDERATIONS}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1678981497_photo_2023-03-16_23-32-05.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CONSEQUENCES OF POLYCYSTIC OVARY SYNDROME}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Metabolic risk} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Cardiovascular risks} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Cancers risk with aging} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Multidisciplinary approach}}} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- With aging} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Cardiovascular disease}}} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Hypertension}}} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Metabolic syndrome }}} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Diabetes}}} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Cancer (endometrial and ovarian)}}} \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CONSEQUENCES OF POLYCYSTIC OVARY SYNDROME}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1678981651_photo_2023-03-16_23-32-27.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{WEIGHT GAIN/OBESITY AND METABOLIC SYNDROME}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Weight → major predictor of abnormal metabolic findings → cardiovascular (CV) disease risks} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Increased abdominal and visceral fat in women with PCOS} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Treatment: lifestyle management} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Metabolic syndrome} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Diabetes}}} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- CV disease (CVD)}}} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{WEIGHT GAIN/OBESITY AND METABOLIC SYNDROME}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Adult Treatment Panel III criteria (3 of 5)}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Waist circumference \textgreater{}88cm} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- High-density lipoprotein} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Triglycerides \textgreater{}150 mg/dl} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Blood pressure \textgreater{}130/85 mmhg} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Fasting blood sugar \textgreater{}110 mg/dl)} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{DIABETES}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Type 2 diabetes mellitus is more prevalent (2-3 times higher)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Screen for diabetes in the overweight population with PCOS} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Oral glucose tolerance test}}} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Management} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Diet and exercise}}} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Metformin - doses of 1500 mg/day}}} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{QUALITY-OF-LIFE ISSUES}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Poor quality of life}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Burden of being overweight} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Having irregular cycles} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Decreased fertility} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Skin concerns such as acne and hirsutism} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Depression} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Anxiety disorder} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CARDIOVASCULAR CONCERNS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Lipid and lipoprotein abnormalities} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Hypothetical scheme for increasing CV risk in women with PCOS with various phenotypes.} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- "Unless a woman with PCOS has "classic" features of PCOS and has diabetes and obesity, there is no evidence for increased CV morbidity and mortality in women with PCOS."} \tn 
% Row Count 7 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CARDIOVASCULAR CONCERNS}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1678982068_photo_2023-03-16_23-32-24.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CANCERS IN POLYCYSTIC OVARY SYNDROME}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Endometrial cancer can begin at a younger age} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Long-term anovulation }}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Unopposed estrogen stimulation of the endometrium}}} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Increased risk for endometrial and ovarian cancer} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Milder phenotypes - little or no increased risk} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Endometrial cancer - increased at least 2-3 fold} \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Ovarian cancer - 2.5 time increased} \tn 
% Row Count 9 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Use of oral contraceptives} \tn 
% Row Count 10 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Metformin - inhibitory effects on various cancers} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CANCERS IN POLYCYSTIC OVARY SYNDROME}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1678982201_photo_2023-03-16_23-32-23.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{OVARIAN AGING: PCOS AND MENOPAUSE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Ovaries decrease in size and androgen levels decrease} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- As women with PCOS age} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Become more regular and ovulatory}}} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Decrease in the total follicular cohort }}} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Lower levels of AMH}}} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{-Preserved fertility in women with PCOS as they age} \tn 
% Row Count 8 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Menopause}}} \tn 
% Row Count 9 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Hirsutism may still be prevalent T }}} \tn 
% Row Count 10 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Persistence of the metabolic issues }}} \tn 
% Row Count 11 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Continued vigilance in managing and following} \tn 
% Row Count 12 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{TREATMENT OF POLYCYSTIC OVARY SYNDROME}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{➤ Androgen excess and symptoms of hyperandrogenism} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{➤Irregular bleeding and risks of endometrial disease as a result of unopposed estrogen stimulation from anovulation} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{➤Fertility concerns and subfertility, mostly because of anovulation} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{ Lifestyle management}}} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Use of an OC, with or without an antiandrogen - Androgen excess} \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- OCS -\textgreater{} Reduce the risk of endometrial cancer}}} \tn 
% Row Count 11 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Supplying the missing progesterone in anovulatory - Irregular bleeding} \tn 
% Row Count 13 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Progestogen therapy}}} \tn 
% Row Count 14 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- 2 to 3-month intervals }}} \tn 
% Row Count 15 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Medroxyprogesterone acetate (5-10mg) }}} \tn 
% Row Count 16 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Norethindrone acetate (2.5 to 10 mg)}}} \tn 
% Row Count 17 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Ovulation induction - subfertility} \tn 
% Row Count 18 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{TREATMENT OF SUBFERTILITY IN PCOS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Ovulation induction}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Metformin }}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Clomiphene - after obtaining a semen analysis}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-Letrozole - 2.5 to 5 mg/day, 5 days; first-line treatment}}} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Gonadotropins - Low-dose is highly effective as a second-line treatment }}} \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-  pulsatile GnRH - less effective}}} \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- ovarian diathermy or drilling - second-line therapy, particularly in clomiphene failures}}} \tn 
% Row Count 10 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Adjunctive measures}}} \tn 
% Row Count 11 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-Dexamethasone}}} \tn 
% Row Count 12 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Dopamine agonists }}} \tn 
% Row Count 13 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-  Thiazolidinediones}}} \tn 
% Row Count 14 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{IVF - fail to conceive with ovulation induction over 6 cycles and with other infertility factors}}} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{METABOLIC AND WEIGHT CONCERNS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Exercise regimens }}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Metabolic syndrome (MBS)}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- Combination of diet and metformin}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\emph{- • Reduce weight by 5-7\%}}} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{-  Reduce insulin resistance Improve metabolic parameters}}} \tn 
% Row Count 6 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Bariatric surgery}}} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Antiandrogens (flutamide)}}} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{ Drospirenone and 17alpha- ethinylestradiol (EE2) with flutamine and metformin - adolescents}}} \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{METABOLIC AND WEIGHT CONCERNS}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/teas_1678982876_photo_2023-03-16_23-32-20.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}